Provider Demographics
NPI:1811571268
Name:SORRENTINO, ELENA ROSE
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:ROSE
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PLYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4628
Mailing Address - Country:US
Mailing Address - Phone:847-494-2714
Mailing Address - Fax:
Practice Address - Street 1:350 PLYMOUTH DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4628
Practice Address - Country:US
Practice Address - Phone:847-494-2714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist